Provider Demographics
NPI:1154432565
Name:GUSTINGER, KARL (DC)
Entity type:Individual
Prefix:DR
First Name:KARL
Middle Name:
Last Name:GUSTINGER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 JUSTICE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3617
Mailing Address - Country:US
Mailing Address - Phone:318-325-6325
Mailing Address - Fax:318-325-6064
Practice Address - Street 1:2107 JUSTICE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3617
Practice Address - Country:US
Practice Address - Phone:318-325-6325
Practice Address - Fax:318-325-6064
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1177111N00000X
FLCH6102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU01506Medicare UPIN